Subtitles and Transcript

Rebecca Onie

0:11
So my freshman year of collegeI signed up for an internship in the housing unitat Greater Boston Legal Services.Showed up the first dayready to make coffee and photocopies,but was paired with this righteous, deeply inspired attorneynamed Jeff Purcell,who thrust me onto the front linesfrom the very first day.

0:32
And over the course of nine monthsI had the chanceto have dozens of conversationswith low-income families in Bostonwho would come in presenting with housing issues,but always had an underlying health issue.So I had a client who came in,about to be evicted because he hasn't paid his rent.But he hasn't paid his rent, of course,because he's paying for his HIV medicationand just can't afford both.We had moms who would come in,daughter has asthma,wakes up covered in cockroaches every morning.And one of our litigation strategieswas actually to send me into the home of these clientswith these large glass bottles.And I would collect the cockroaches,hot glue-gun them to this poster boardthat we'd bring to court for our cases.And we always wonbecause the judges were just so grossed out.Far more effective, I have to say,than anything I later learned in law school.

1:26
But over the course of these nine months,I grew frustrated with feelinglike we were intervening too far downstreamin the lives of our clients --that by the time they came to us,they were already in crisis.And at the end of my freshman year of college,I read an article about the workthat Dr. Barry Zuckerman was doingas Chair of Pediatricsat Boston Medical Center.And his first hire was a legal services attorneyto represent the patients.

1:54
So I called Barry,and with his blessing, in October 1995walked into the waiting roomof the pediatrics clinic at Boston Medical Center.I'll never forget,the TVs played this endless reel of cartoons.And the exhaustion of motherswho had taken two, three, sometimes four busesto bring their child to the doctorwas just palpable.

2:18
The doctors, it seemed,never really had enough time for all the patients,try as they might.And over the course of six months,I would corner them in the hallwayand ask them a sort of naive but fundamental question:"If you had unlimited resources,what's the one thing you would give your patients?"

2:34
And I heard the same story again and again,a story we've heard hundreds of times since then.They said, "Every day we have patients that come into the clinic --child has an ear infection,I prescribe antibiotics.But the real issue is there's no food at home.The real issueis that child is living with 12 other peoplein a two-bedroom apartment.And I don't even ask about those issuesbecause there's nothing I can do.I have 13 minutes with each patient.Patients are piling up in the clinic waiting room.I have no idea where the nearest food pantry is.And I don't even have any help."In that clinic, even today,there are two social workersfor 24,000 pediatric patients,which is better than a lot of the clinics out there.

3:18
So Health Leads was born of these conversations --a simple modelwhere doctors and nursescan prescribe nutritious food,heat in the winterand other basic resources for their patientsthe same way they prescribe medication.Patients then take their prescriptionsto our desk in the clinic waiting roomwhere we have a core of well-trained college student advocateswho work side by side with these familiesto connect them outto the existing landscape of community resources.

3:47
So we began with a card table in the clinic waiting room --totally lemonade stand style.But today we have a thousand college student advocateswho are working to connect nearly 9,000 patients and their familieswith the resources that they need to be healthy.

4:04
So 18 months agoI got this email that changed my life.And the email was from Dr. Jack Geiger,who had written to congratulate me on Health Leadsand to share, as he said,a bit of historical context.In 1965 Dr. Geiger foundedone of the first two community health centers in this country,in a brutally poor area in the Mississippi Delta.And so many of his patients came inpresenting with malnutritionthat be began prescribing food for them.And they would take these prescriptions to the local supermarket,which would fill themand then charge the pharmacy budget of the clinic.And when the Office of Economic Opportunity in Washington, D.C. --which was funding Geiger's clinic --found out about this,they were furious.And they sent this bureaucrat downto tell Geiger that he was expected to use their dollarsfor medical care --to which Geiger famously and logically responded,"The last time I checked my textbooks,the specific therapy for malnutrition was food."

5:04
(Laughter)

5:06
So when I got this email from Dr. Geiger,I knew I was supposed to be proudto be part of this history.But the truth isI was devastated.Here we are,45 years after Geiger has prescribed food for his patients,and I have doctors telling me,"On those issues, we practice a 'don't ask, don't tell' policy."Forty-five years after Geiger,Health Leads has to reinventthe prescription for basic resources.So I have spent hours upon hourstrying to make sense of this weird Groundhog Day.How is it that if for decadeswe had a pretty straightforward tool for keeping patients,and especially low-income patients, healthy,that we didn't use it?If we know what it takes to have a healthcare systemrather than a sick-care system,why don't we just do it?

5:58
These questions, in my mind,are not hard because the answers are complicated,they are hard because they require that we be honest with ourselves.My belief is that it's almost too painfulto articulate our aspirations for our healthcare system,or even admit that we have any at all.Because if we did,they would be so removedfrom our current reality.But that doesn't change my beliefthat all of us, deep inside,here in this room and across this country,share a similar set of desires.That if we are honest with ourselvesand listen quietly,that we all harborone fiercely held aspiration for our healthcare:that it keep us healthy.

6:47
This aspiration that our healthcare keep us healthyis an enormously powerful one.And the way I think about thisis that healthcare is like any other system.It's just a set of choices that people make.What if we decidedto make a different set of choices?What if we decided to take all the parts of healthcarethat have drifted away from usand stand firm and say, "No.These things are ours.They will be used for our purposes.They will be used to realizeour aspiration"?What if everything we neededto realize our aspiration for healthcarewas right there in front of usjust waiting to be claimed?

7:27
So that's where Health Leads began.We started with the prescription pad --a very ordinary piece of paper --and we asked, not what do patients need to get healthy --antibiotics, an inhaler, medication --but what do patients need to be healthy,to not get sick in the first place?And we chose to use the prescriptionfor that purpose.So just a few miles from hereat Children's National Medical Center,when patients come into the doctor's office,they're asked a few questions.They're asked, "Are you running out of food at the end of the month?Do you have safe housing?"And when the doctor begins the visit,she knows height, weight, is there food at home,is the family living in a shelter.And that not only leads to a better set of clinical choices,but the doctor can also prescribe those resources for the patient,using Health Leads like any other sub-specialty referral.

8:17
The problem is,once you get a taste of what it's liketo realize your aspiration for healthcare,you want more.So we thought,if we can get individual doctorsto prescribe these basic resources for their patients,could we get an entire healthcare systemto shift its presumption?And we gave it a shot.

8:38
So now at Harlem Hospital Centerwhen patients come in with an elevated body mass index,the electronic medical recordautomatically generates a prescription for Health Leads.And our volunteers can then work with themto connect patients to healthy food and excercise programsin their communities.We've created a presumptionthat if you're a patient at that hospitalwith an elevated BMI,the four walls of the doctor's officeprobably aren't going to give you everythingyou need to be healthy.You need more.

9:06
So on the one hand,this is just a basic recodingof the electronic medical record.And on the other hand,it's a radical transformationof the electronic medical recordfrom a static repository of diagnostic informationto a health promotion tool.In the private sector,when you squeeze that kind of additional valueout of a fixed-cost investment,it's called a billion-dollar company.But in my world,it's called reduced obesity and diabetes.It's called healthcare --a system where doctors can prescribe solutionsto improve health,not just manage disease.

9:43
Same thing in the clinic waiting room.So every day in this countrythree million patientspass through about 150,000 clinic waiting rooms in this country.And what do they do when they're there?They sit, they watch the goldfish in the fish tank,they read extremely old copiesof Good Housekeeping magazine.But mostly we all just sit there forever, waiting.How did we get herewhere we devote hundreds of acres and thousands of hoursto waiting?What if we had a waiting roomwhere you don't just sit when you're sick,but where you go to get healthy.If airports can become shopping mallsand McDonald's can become playgrounds,surely we can reinvent the clinic waiting room.

10:27
And that's what Health Leads has tried to do,to reclaim that real estate and that timeand to use it as a gatewayto connect patientsto the resources they need to be healthy.So it's a brutal winter in the Northeast,your kid has asthma, your heat just got turned off,and of course you're in the waiting room of the ER,because the cold air triggered your child's asthma.But what if instead of waiting for hours anxiously,the waiting room became the placewhere Health Leads turned your heat back on?

10:53
And of course all of this requiresa broader workforce.But if we're creative, we already have that too.We know that our doctors and nursesand even social workersaren't enough,that the ticking minutes of health careare too constraining.Health just takes more time.It requires a non-clinical armyof community health workers and case managersand many others.

11:17
What if a small part of that next healthcare workforcewere the 11 million college students in this country?Unencumbered by clinical responsibilities,unwilling to take no for an answerfrom those bureaucraciesthat tend to crush patients,and with an unparalleled abilityfor information retrievalhoned through years of using Google.

11:39
Now lest you think it improbablethat a college volunteercan make this kind of commitment,I have two words for you:March Madness.The average NCAA Division I men's basketball playerdedicates 39 hours a week to his sport.Now we may think that's good or bad,but in either case it's real.And Health Leads is based on the presumptionthat for too longwe have asked too little of our college studentswhen it comes to real impact in vulnerable communities.College sports teams say,"We're going to take dozens of hoursat some field across campus at some ungodly hour of the morningand we're going to measure your performance, and your team's performance,and if you don't measure up or you don't show up,we're going to cut you off the team.But we'll make huge investmentsin your training and development,and we'll give you an extraordinary community of peers."And people line up out the doorjust for the chance to be part of it.

12:54
Now in the top 10 cities in the U.S.with the largest number of Medicaid patients,each of those has at least 20,000 college students.New York alone has half a million college students.And this isn't just a sort of short-term workforceto connect patients to basic resources,it's a next generation healthcare leadership pipelinewho've spent two, three, four yearsin the clinic waiting roomtalking to patients about their most basic health needs.And they leave with the conviction,the ability and the efficacyto realize our most basic aspirations for health care.And the thing is, there's thousands of these folks already out there.

13:32
So Mia Lozada is Chief Resident of Internal Medicineat UCSF Medical Center,but for three years as an undergraduateshe was a Health Leads volunteerin the clinic waiting room at Boston Medical Center.Mia says, "When my classmates write a prescription,they think their work is done.When I write a prescription,I think, can the family read the prescription?Do they have transportation to the pharmacy?Do they have food to take with the prescription?Do they have insurance to fill the prescription?Those are the questions I learned at Health Leads,not in medical school."

14:06
Now none of these solutions --the prescription pad, the electronic medical record,the waiting room,the army of college students --are perfect.But they are ours for the taking --simple examplesof the vast under-utilized healthcare resourcesthat, if we reclaimed and redeployed,could realize our most basic aspirationof healthcare.

14:30
So I had been at Legal Services for about nine monthswhen this idea of Health Leads started percolating in my mind.And I knew I had to tell Jeff Purcell, my attorney,that I needed to leave.And I was so nervous,because I thought he was going to be disappointed in mefor abandoning our clients for some crazy idea.And I sat down with him and I said,"Jeff, I have this ideathat we could mobilize college studentsto address patients' most basic health needs."And I'll be honest,all I wanted was for him to not be angry at me.But he said this,"Rebecca, when you have a vision,you have an obligation to realize that vision.You must pursue that vision."And I have to say, I was like "Whoa.That's a lot of pressure."I just wanted a blessing,I didn't want some kind of mandate.But the truth isI've spent every waking minute nearly since thenchasing that vision.

15:27
I believe that we all have a visionfor healthcare in this country.I believe that at the end of the daywhen we measure our healthcare,it will not be by the diseases cured,but by the diseases prevented.It will not be by the excellence of our technologiesor the sophistication of our specialists,but by how rarely we needed them.And most of all,I believe that when we measure healthcare,it will be, not by what the system was,but by what we chose it to be.